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Early extracorporeal membrane oxygenator-assisted primary percutaneous coronary intervention improved 30-day outcomes in patients with ST-segment elevation myocardial infarction with complicated with profound cardiogenic shock.

dKlebsiella pneumoniae is an important human pathogen associated with a variety of diseases, and the prevalence of multidrugresistant K. pneumoniae (MDRKP) is rapidly increasing. Here we determined the capsular types of 85 carbapenem-resistant K. pneumoniae (CRKP) strains by wzc sequencing and investigated the presence of carbapenemases and integrons among CRKP strains. Ten CRKP strains (12%) were positive for carbapenemase (imipenemase, 6/85 strains; K. pneumoniae carbapenemase, 3/85 strains; Verona integron-encoded metallo-␤-lactamase, 1/85 strains). Capsular type K64 accounted for 32 CRKP strains (38%), followed by K62 (13%), K24 (8%), KN2 (7%), and K28 (6%). Sequence types (STs) were determined by multilocus sequence typing (MLST), and the results indicated that ST11, which accounted for 47% of these CRKP strains (40/85 strains), was the major ST. We further isolated a K64-specific capsule depolymerase (K64dep), which could enhance serum and neutrophil killing in vitro and increase survival rates for K64 K. pneumoniae-inoculated mice. The toxicity study demonstrated that mice treated with K64dep showed normal biochemical parameters and no significant histopathological changes of liver, kidney, and spleen, indicating that enzyme treatment did not cause toxicity in mice. Therefore, the findings of capsular type clustering among CRKP strains and effective treatment with capsule depolymerase for MDRKP infections are important for capsule-based vaccine development and therapy.K lebsiella pneumoniae, a Gram-negative bacillus, causes hospital or community-acquired disease (1-3). Most K. pneumoniae strains harbor chromosome-encoded SHV ␤-lactamase (4). In 1983, the emergence of K. pneumoniae strains producing a mutant of SHV-1 ␤-lactamase that hydrolyzes extended-spectrum cephalosporins was observed in Germany (5); subsequently, K. pneumoniae strains resistant to third-generation cephalosporins were detected in France, and a new ␤-lactamase gene closely related to TEM-1 and TEM-2 was identified (6). In 1989, the CTX-M type was reported as a new extended-spectrum ␤-lactamase (ESBL) family member not belonging to either the TEM type or the SHV type (7), and subsequently it was considered one of the major ESBL types (8). Recent global surveillance data from Europe, North and South America, and Asia revealed that the frequency of ESBL-producing K. pneumoniae was 7.5 to 44% (9). As the prevalence of ESBL-producing isolates increased, carbapenems were used to treat serious infections caused by ESBL-producing K. pneumoniae. However, carbapenem-resistant K. pneumoniae (CRKP) rates have been dramatically increasing worldwide over the past 10 years. In the United States, a significant increase in CRKP prevalence from Ͻ1% in 2000 to 8% in 2007 was reported (10). In addition, data from the National Healthcare Safety Network (NHSN) showed that, in 2006 and 2007, CRKP was reported for up to 10.8% of total isolates associated with certain device-related infections (11). In Italy, CRKP increased rapidly from 1 to 2% in 2006 to 2009...

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Cox A6 is among the major serotypes of enteroviruses in Taiwan and most cases presented as herpangina and hand-foot-mouth disease. Nearly half of the cases may have leukocytosis and elevated CRP levels. Outcomes are usually good.

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Little is known about the mechanism of necrotizing pneumonia caused by Streptococcus pneumoniae in children. Pulmonary gangrene secondary to vascular thrombosis was reported in adults with necrotizing pneumococcal pneumonia. We conducted a retrospective study of 15 children with a diagnosis of necrotizing pneumococcal pneumonia at National Taiwan University Hospital to explore its association with pulmonary gangrene, based on evidence from chest computed tomography, serial chest radiographic patterns, and pathologic results. S. pneumoniae serotype 14 was the prevalent pneumococcal serotype. Overall, 63.6% of isolates were not susceptible to penicillin. One child with pneumonia caused by S. pneumoniae serotype 3 complicated by hemolytic uremic syndrome had a rapidly fatal course. An autopsy in this patient documented lung necrosis and pulmonary gangrene. Radiographic follow-up was performed during the clinical course in 9 patients, and showed no evidence of pulmonary gangrene. Four children had no radiographic follow-up. The relationship between pulmonary gangrene and necrotizing pneumonia was unclear in the remaining one. In conclusion, necrotizing pneumococcal pneumonia may be infrequently associated with pulmonary gangrene in children.